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Merlo EM, Tutino R, Myles LAM, Lia MC, Minasi D. Alexithymia, intolerance to uncertainty and mental health difficulties in adolescents with Type 1 diabetes mellitus. Ital J Pediatr 2024; 50:99. [PMID: 38755698 PMCID: PMC11100042 DOI: 10.1186/s13052-024-01647-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 04/07/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Type 1 Diabetes Mellitus (T1DM) represents a serious chronic condition affecting a wide number of people. Discussion of the physical issues associated with T1DM pervades the literature, however, there is less discussion of the psychological consequences. Mental health difficulties, alexithymia and uncertainty are present in this population, and known to be harmful for the onset, maintenance and worsening of T1DM. This study aimed to evaluate the presence of these phenomena in people with T1DM. METHODS 105 participants aged between 11 and 17 years old (M: 13.88; SD: 2.16) affected by T1DM were included in the sample. To assess the presence of mental health difficulties, SAFA scales (Depression, Anxiety and Somatic symptoms) were included in the protocol together with TAS-20 and IUS-12, which evaluate the presence and role of alexithymia and intolerance to uncertainty in the sample, respectively. RESULTS A concerning presence of anxiety, depression and somatic symptoms was found in the sample. Mental health difficulties appeared to be consistently present in the sample, often overcoming pathological thesholds. Alexithymia and uncertainty were also common, highlighting their role in T1DM. CONCLUSIONS Active mental health difficulties together with high rates of alexithymia and intolerance to uncertainty were prevalent in the sample of adolescents with diabetes.
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Affiliation(s)
- Emanuele Maria Merlo
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy.
| | - Rita Tutino
- Pediatric Unit of Ospedali Riuniti Presidium, Grande Ospedale Metropolitano Bianchi Melacrino Morelli, Reggio Calabria, Italy
| | | | - Maria Carmela Lia
- Pediatric Unit of Ospedali Riuniti Presidium, Grande Ospedale Metropolitano Bianchi Melacrino Morelli, Reggio Calabria, Italy
| | - Domenico Minasi
- Pediatric Unit of Ospedali Riuniti Presidium, Grande Ospedale Metropolitano Bianchi Melacrino Morelli, Reggio Calabria, Italy
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Garrett CJ, Moulton CD, Choudhary P, Amiel SA, Fonagy P, Ismail K. The psychopathology of recurrent diabetic ketoacidosis: A case-control study. Diabet Med 2021; 38:e14505. [PMID: 33368581 DOI: 10.1111/dme.14505] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 12/14/2020] [Accepted: 12/21/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Despite its poor prognosis, the psychological factors associated with recurrent diabetic ketoacidosis are poorly understood. In people with type 1 diabetes, we assessed for psychopathology in those with and without recurrent diabetic ketoacidosis (DKA). METHOD The design was a case-control study. Cases were defined as people with two or more DKA episodes in a 12-month period (recurrent DKA). Cases and controls were matched for gender and age. We compared groups for scores on Beck's Anxiety Inventory (BAI), Beck's Depression Inventory II, Difficulty in Emotion Regulation Scale (DERS), Experiences in Close Relationships-Revised, Standardised Assessment of Personality-Abbreviated Scale (SAPAS), Interpersonal Problem Inventory, Eating Disorder Examination Questionnaire and Problem Areas in Diabetes (PAID) using unpaired t-tests or Mann-Whitney U tests for parametric and non-parametric data, respectively. Correction was made for multiple testing. RESULTS In all, 23 cases and 23 controls were recruited with mean age 31.0 (11.4) years and 65.2% were men. Cases had higher HbA1c levels than controls (101.1 (23.2) vs. 85.7 (21.7) mmol/mol, (p = 0.02)). Compared to controls, people with recurrent DKA had higher scores on the BAI (p = 0.004), PAID (p = 0.004), DERS (p = 0.001) and SAPAS (p < 0.001). Sixteen of 23 (69.6%) cases screened positive for a personality disorder compared to 6 of 23 (26.1%) controls. CONCLUSIONS People with recurrent DKA have elevated levels of anxiety and diabetes distress, greater difficulty with emotion regulation and personality dysfunction compared to matched controls.
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Affiliation(s)
- Christopher J Garrett
- Diabetes and Metabolism Department, Barts Health NHS Trust, London, UK
- Diabetes, Psychiatry and Psychology Research Group, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Calum D Moulton
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Pratik Choudhary
- Division of Diabetes and Nutritional Sciences, King's College London, London, UK
| | - Stephanie A Amiel
- Division of Diabetes and Nutritional Sciences, King's College London, London, UK
| | - Peter Fonagy
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Khalida Ismail
- Diabetes, Psychiatry and Psychology Research Group, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Marchini F, Caputo A, Convertino A, Napoli A. Psychodynamics in Diabetes: The Relevance of Deepening the Symbolic in Treatment Adherence. Front Psychol 2021; 12:661211. [PMID: 34017293 PMCID: PMC8130673 DOI: 10.3389/fpsyg.2021.661211] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 03/19/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Francesco Marchini
- Italian Centre of Analytical Psychology (CIPA), "Sapienza" University of Rome, Rome, Italy
| | - Andrea Caputo
- Department of Dynamic and Clinical Psychology, and Health Studies, "Sapienza" University of Rome, Rome, Italy
| | - Alessio Convertino
- Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Angela Napoli
- Department of Clinical and Molecular Medicine, "Sapienza" University of Rome, Rome, Italy
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Martino G, Caputo A, Vicario CM, Catalano A, Schwarz P, Quattropani MC. The Relationship Between Alexithymia and Type 2 Diabetes: A Systematic Review. Front Psychol 2020; 11:2026. [PMID: 32982843 PMCID: PMC7484475 DOI: 10.3389/fpsyg.2020.02026] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 07/21/2020] [Indexed: 12/14/2022] Open
Abstract
Background: This systematic review analyzed the relationship between alexithymia, considered as the inability to recognize and express thoughts and emotions, and type 2 diabetes mellitus (T2DM), one of the most common chronic illness, characterized by a metabolic disorder burdened by high morbidity and mortality worldwide due to its outcomes. Methods: PRISMA guidelines were followed throughout this systematic review of the recent literature indexed in the databases PubMed, PsycInfo, Scopus, and Web of Science. Search terms for eligible studies were: "Type 2 diabetes" OR "T2DM" AND "Toronto Alexithymia Scale" OR "TAS-20"[All Fields]. Results: The initial search identified 61 indexed scientific publications. After screening we found that seven publications met the established scientific inclusion and exclusion criteria. It emerged that alexithymic patients ranged from 25 to 50% across the examined publications and it appeared that patients with T2DM generally reflected greater values of alexithymia, revealing particular differences among TAS domains. Moreover, emlpoyed participants were alexithymic to a greater extent compared to non-working participants (77.8 vs. 35.4%) and alexithymia was 2.63 times more severe among working participants when examining predictors of alexithymia. When evaluating the correlations between alexithymia and HbA1c or fasting blood glucose levels we found strong associations equal to 0.75 and 0.77 for TAS-20 total scores, respectively. While alexithymic participants showed significantly higher levels of HbA1c and blood glucose when compared to the non-alexithymic participants. Conclusions: The results of this systematic review of the current literature highlight the need of alexithymia evaluation in patients with T2DM. The high prevalence in T2DM and strong associations with poorly regulated diabetes and psychological distress, indicate a significant relationship between poor glycemic control and psychological distress, such as anxiety and depression, and quality of life. Further studies are needed focusing on age and gender differences in order to be able to improve clinical psychological care and prevention.
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Affiliation(s)
- Gabriella Martino
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Andrea Caputo
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy
| | - Carmelo M. Vicario
- Department of Cognitive Sciences, Psychology, Education and Cultural Studies, University of Messina, Messina, Italy
| | - Antonino Catalano
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Peter Schwarz
- Department of Medical Endocrinology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Maria C. Quattropani
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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Aluja A, Malas O, Urieta P, Worner F, Balada F. Biological correlates of the Toronto Alexithymia Scale (TAS-20) in cardiovascular disease and healthy community subjects. Physiol Behav 2020; 227:113151. [PMID: 32841673 DOI: 10.1016/j.physbeh.2020.113151] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 07/24/2020] [Accepted: 08/21/2020] [Indexed: 11/26/2022]
Abstract
This research studies the relationship between Alexithymia, behavioural, biometric, biochemical and cardiovascular risk in clinical and healthy samples. There were 602 participants (mean age of 52.82 ± 10.59) divided into two groups. The first was made up of 202 patients (165 males and 37 females) who had suffered a cardiovascular disease (CVD), while the second was composed of 400 (285 males and 115 females) healthy volunteers without CVD diagnosis. A cardiovascular risk index (CRI) was developed with the high factorial loading of the following variables: systolic and diastolic blood pressure, total cholesterol/HDL, triglycerides, body mass index, glucose and alcohol and tobacco consumption. The results showed a significant correlation between Alexithymia and the CRI. After controlling for age, sex, occupation, alcohol and tobacco consumption, this correlation decreased, but remained significant for most values. Alexithymia predicted 6% of CRI in the entire sample, once age and sex effect were discounted. Alexithymic subjects with scores above a cut-off point set at higher than 60 had higher levels of glucose, systolic, diastolic, cholesterol/HDL and cardiovascular risk. We discuss that Alexithymia scores contribute to cardiovascular risk, supporting previous findings.
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Affiliation(s)
- Anton Aluja
- University of Lleida, Catalonia, Spain; Institute of Biomedical Research, Lleida, Catalonia, Spain.
| | - Olga Malas
- Institute of Biomedical Research, Lleida, Catalonia, Spain
| | - Patricia Urieta
- University of Lleida, Catalonia, Spain; Institute of Biomedical Research, Lleida, Catalonia, Spain
| | - Fernando Worner
- Institute of Biomedical Research, Lleida, Catalonia, Spain; Cardiology Service of the Hospital Arnau de Vilanova de Lleida, Spain
| | - Ferran Balada
- Institute of Biomedical Research, Lleida, Catalonia, Spain; Universitat Autònoma de Barcelona. Catalonia. Spain
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Shayeghian Z, Moeineslam M, Hajati E, Karimi M, Amirshekari G, Amiri P. The relation of alexithymia and attachment with type 1 diabetes management in adolescents: a gender-specific analysis. BMC Psychol 2020; 8:30. [PMID: 32252831 PMCID: PMC7137281 DOI: 10.1186/s40359-020-00396-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 03/19/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Several studies indicate the role of psychosocial factors in the management and control of chronic diseases in adolescents. In this regard, the roles of attachment and alexithymia in the management of type 1 diabetes in adolescents and related gender-specific patterns have rarely been the focus of empirical research. In this study we investigate the gender-specific relationship of alexithymia and attachment with self-care and blood glucose level in adolescents with type1 diabetes. METHODS This is a cross-sectional study conducted on adolescents aged 12-18 years, with type 1 diabetes. Participants were recruited from diabetes clinics and the Iranian Diabetes Society. Data were collected using the Farsi versions of the Toronto Alexithymia Scale (FTAS-20), the Inventory of Parent and Peer Attachment (IPPA) and the Summary of Diabetes Self-Care Activities Scale (SDSCA). Blood glucose levels were measured by determining HbA1c which were abstracted from medical records. Data were analyzed using SPSS21 software. RESULTS Participants were 150 adolescents (57% female), mean age 14.97 ± 2.30. Alexithymia (β = 0.10, P = 0.01), difficulty identifying feelings (β = 0.15, P = 0.03) and communication with mothers (β = - 0.08, P = 0.03) predicted HbA1c in girls, whereas no significant relationships were observed for HbA1c with alexithymia and attachment in boys. Factors that predicted self-care in girls were alexithymia (β = - 0.04, P = 0.02), difficulty identifying feelings (β = - 0.06, P = 0.04); in boys however in addition to these two factors predicting self-care [alexithymia (β = - 0.07, P = 0.01) and difficulty identifying feelings (β = - 0.11, P = 0.01)], we also found difficulty describing feelings (β = - 0.16, P = 0.02), communication with mother (β = 0.04, P = 0.04), alienation to mother (β = - 0.06, P = 0.03), to father (β = - 0.06, P = 0.01) and to peers (β = - 0.09, P = 0.03). CONCLUSIONS Our results suggest that, in a gender-specific pattern, alexithymia and attachment could affect self-care and blood glucose level in adolescents with type 1 diabetes; findings that can be used to facilitate more effective treatment strategies and interventions in this age group.
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Affiliation(s)
- Zeinab Shayeghian
- Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O.Box: 19395-4763, Tehran, Iran
| | - Mina Moeineslam
- Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O.Box: 19395-4763, Tehran, Iran
| | - Elnaz Hajati
- Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O.Box: 19395-4763, Tehran, Iran
| | - Mehrdad Karimi
- Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O.Box: 19395-4763, Tehran, Iran.,Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Golshan Amirshekari
- Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O.Box: 19395-4763, Tehran, Iran
| | - Parisa Amiri
- Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O.Box: 19395-4763, Tehran, Iran.
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Schinckus L, Avalosse H, Van den Broucke S, Mikolajczak M. The role of trait emotional intelligence in diabetes self-management behaviors: The mediating effect of diabetes-related distress. Personality and Individual Differences 2018; 131:124-31. [DOI: 10.1016/j.paid.2018.03.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Chen L, Xu L, You W, Zhang X, Ling N. Prevalence and associated factors of alexithymia among adult prisoners in China: a cross-sectional study. BMC Psychiatry 2017; 17:287. [PMID: 28768497 PMCID: PMC5541430 DOI: 10.1186/s12888-017-1443-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 07/24/2017] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Prison is an extremely stressful environment and prisoners have an increasing risk of suffering from alexithymia. Therefore, this study aims to investigate the prevalence and associated factors of alexithymia among prisoners in China. METHODS A cross-sectional study was conducted in five main jails of the district of Zhejiang province in China, and a total of 1705 adult prisoners ultimately took part in the study. Toronto Alexithymia Scale, Childhood Trauma Questionnaire, Beck Depression Inventory, Beck Anxiety Inventory, Beck Hopelessness Scale and several short demographic questions were applied. RESULTS Over 30% of prisoners were classified as alexithymics and as high as 96.2% of prisoners suffered from at least one traumatic experience in their childhood, meanwhile, 81.5%, 53.4% and 85.8% were found to be positive for depression, anxiety and hopelessness symptoms respectively. Education, childhood trauma, negative emotional symptoms including depression, anxiety and hopelessness of the respondents, were negatively or positively associated with alexithymia among prisoners. CONCLUSIONS The results indicated that high prevalence of alexithymia among prisoners is linked with their level of education, experience of childhood trauma and symptoms of negative emotions. Accordingly, the findings in our study can be used for prevention and intervention of alexithymia among prisoners.
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Affiliation(s)
- Li Chen
- Department of Applied Psychology, Wenzhou Medical University, Wenzhou, 325035, China.
| | - Linna Xu
- 0000 0001 2151 7947grid.265850.cDepartment of Economics, University at Albany, State University of New York, Albany, NY USA
| | - Weimin You
- Public Security Sub-Bureau of Huangyan, Taizhou Public Security Bureau, Huangyan, China
| | - Xiaoyan Zhang
- 0000 0004 1764 2632grid.417384.dDepartment of Children’s Health Care, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Murphy J, Brewer R, Catmur C, Bird G. Interoception and psychopathology: A developmental neuroscience perspective. Dev Cogn Neurosci 2017; 23:45-56. [PMID: 28081519 PMCID: PMC6987654 DOI: 10.1016/j.dcn.2016.12.006] [Citation(s) in RCA: 194] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 12/19/2016] [Accepted: 12/19/2016] [Indexed: 12/15/2022] Open
Abstract
Interoception refers to the perception of the physiological condition of the body, including hunger, temperature, and heart rate. There is a growing appreciation that interoception is integral to higher-order cognition. Indeed, existing research indicates an association between low interoceptive sensitivity and alexithymia (a difficulty identifying one's own emotion), underscoring the link between bodily and emotional awareness. Despite this appreciation, the developmental trajectory of interoception across the lifespan remains under-researched, with clear gaps in our understanding. This qualitative review and opinion paper provides a brief overview of interoception, discussing its relevance for developmental psychopathology, and highlighting measurement issues, before surveying the available work on interoception across four stages of development: infancy, childhood, adolescence and late adulthood. Where gaps in the literature addressing the development of interoception exist, we draw upon the association between alexithymia and interoception, using alexithymia as a possible marker of atypical interoception. Evidence indicates that interoceptive ability varies across development, and that this variance correlates with established age-related changes in cognition and with risk periods for the development of psychopathology. We suggest a theory within which atypical interoception underlies the onset of psychopathology and risky behaviour in adolescence, and the decreased socio-emotional competence observed in late adulthood.
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Affiliation(s)
- Jennifer Murphy
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.
| | - Rebecca Brewer
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK; School of Psychology, The University of East London, London, UK
| | - Caroline Catmur
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Geoffrey Bird
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK; Institute of Cognitive Neuroscience, UCL, London, UK; Dept of Experimental Psychology, University of Oxford, Oxford, UK
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Abstract
OBJECTIVE This study was aimed at determining the prevalence of alexithymia in patients with type 2 DM and the factors affecting it. METHODS This cross-sectional study was conducted with 326 patients with type 2 DM. Study data were collected with the Personal Information Form, Toronto Alexithymia Scale, and Hospital Anxiety and Depression Scale. Glycemic control was assessed by glycated haemoglobin (HbA1c) results. The analysis was performed using descriptive statistics, chi-square test, Pear-son's correlation, and logistic regression analysis. RESULTS Of the patients, 37.7% were determined to have alexithymia. A significant relationship was determined between alexithymia and HbA1c, depression, and anxiety. According to binary logistic regression analyses, alexithymia was 2.63 times higher among those who were in a paid employment than those who were not, 2.09 times higher among those whose HbA1c levels were ≥7.0% than those whose HbA1c levels were <7.0%, 3.77 times higher among those whose anxiety subscale scores were ≥11 than those whose anxiety subscale scores were ≤10, and 2.57 times higher among those whose depression subscale scores were ≥8 than those whose depression subscale scores were ≤7. CONCLUSION In this study, it was determined that two out of every five patients with DM had alexithymia. Therefore, their treatment should be arranged to include mental health care services.
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Affiliation(s)
- Dilek Avci
- Department of Nursing, Faculty of Health Sciences, Bandirma Onyedi Eylul University, Balikesir
| | - Meral Kelleci
- Department of Nursing, Faculty of Health Sciences, Cumhuriyet University, Sivas, Turkey
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Housiaux M, Luminet O, Dorchy H. Difficulties describing feelings to others still predicts glycaemic control up to 24 months later in children with type 1 diabetes. Diabetes Metab 2016; 42:207-10. [PMID: 26782009 DOI: 10.1016/j.diabet.2015.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 12/10/2015] [Accepted: 12/11/2015] [Indexed: 01/09/2023]
Affiliation(s)
- M Housiaux
- Department of Psychology, Université catholique de Louvain (UCL), Research Institute for Psychological Sciences, 10, Place Cardinal-Mercier, 1348 Louvain-la-Neuve, Belgium
| | - O Luminet
- Department of Psychology, Université catholique de Louvain (UCL), Research Institute for Psychological Sciences, 10, Place Cardinal-Mercier, 1348 Louvain-la-Neuve, Belgium; Belgian National Fund for Scientific Research (FRS-FNRS), Belgium.
| | - H Dorchy
- Diabetology Clinic, University Children's Hospital Queen Fabiola, Université libre de Bruxelles (ULB), 15, Avenue J.J.-Crocq, 1020 Bruxelles, Belgium
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Francoeur RB. Symptom profiles of subsyndromal depression in disease clusters of diabetes, excess weight, and progressive cerebrovascular conditions: a promising new type of finding from a reliable innovation to estimate exhaustively specified multiple indicators-multiple causes (MIMIC) models. Diabetes Metab Syndr Obes 2016; 9:391-416. [PMID: 28003768 PMCID: PMC5158170 DOI: 10.2147/dmso.s118432] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Addressing subsyndromal depression in cerebrovascular conditions, diabetes, and obesity reduces morbidity and risk of major depression. However, depression may be masked because self-reported symptoms may not reveal dysphoric (sad) mood. In this study, the first wave (2,812 elders) from the New Haven Epidemiological Study of the Elderly (EPESE) was used. These population-weighted data combined a stratified, systematic, clustered random sample from independent residences and a census of senior housing. Physical conditions included progressive cerebrovascular disease (CVD; hypertension, silent CVD, stroke, and vascular cognitive impairment [VCI]) and co-occurring excess weight and/or diabetes. These conditions and interactions (clusters) simultaneously predicted 20 depression items and a latent trait of depression in participants with subsyndromal (including subthreshold) depression (11≤ Center for Epidemiologic Studies Depression Scale [CES-D] score ≤27). The option for maximum likelihood estimation with standard errors that are robust to non-normality and non-independence in complex random samples (MLR) in Mplus and an innovation created by the author were used for estimating unbiased effects from latent trait models with exhaustive specification. Symptom profiles reveal masked depression in 1) older males, related to the metabolic syndrome (hypertension-overweight-diabetes; silent CVD-overweight; and silent CVD-diabetes) and 2) older females or the full sample, related to several diabetes and/or overweight clusters that involve stroke or VCI. Several other disease clusters are equivocal regarding masked depression; a couple do emphasize dysphoric mood. Replicating findings could identify subgroups for cost-effective screening of subsyndromal depression.
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Affiliation(s)
- Richard B Francoeur
- School of Social Work, Adelphi University, Garden City, NY, USA
- Correspondence: Richard B Francoeur, School of Social Work, Social Work Building, Adelphi University, 1 South Avenue, Garden City, NY 11530, USA, Tel +1 917 254 7271, Email
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Luca A, Luca M, Di Mauro M, Palermo F, Rampulla F, Calandra C. Alexithymia, more than depression, influences glycaemic control of type 2 diabetic patients. J Endocrinol Invest 2015; 38:653-60. [PMID: 25596663 DOI: 10.1007/s40618-015-0238-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Accepted: 01/05/2015] [Indexed: 12/27/2022]
Abstract
PURPOSE Psychiatric disorders could affect the patients' abilities to cope with diabetes. The objectives of this study were to assess the prevalence of depression and alexithymia among type 2 diabetic patients and investigate the possible correlations between these psychopathological phenomena and glycaemic control assessed through glycated hemoglobin (HbA1c). METHODS All the patients were evaluated through 20-item Toronto Alexithymia Scale (TAS-20), Hamilton rating scale for depression and Quality of Life Index. HbA1c values, diabetes duration, therapy and socio-demographic characteristics were recorded. RESULTS One hundred and twenty-eight patients (75 males and 53 female, mean age 64.7 ± 11.2 years) were enrolled. Alexithymic patients, compared to non-alexithymic ones, presented a significantly higher HbA1c (7.7 ± 1.5 vs. 7 ± 1.5, p = 0.016). No statistically significant difference was found when comparing the HbA1c of depressed versus non-depressed patients. Considering the raw values of HbA1c, the higher percentage was recorded among patients suffering from depression plus alexithymia (comorbidity group) followed by patients presenting alexithymia only, patients with neither depression nor alexithymia (control group) and, finally, those presenting depression only. The comorbidity group presented a significantly higher value of HbA1c (7.7 ± 1.2) than the control group (7 ± 1.6, p < 0.04) and the depressed patients (6.9 ± 1.3, p = 0.04). At the logistic regression, the HbA1c was found to be significantly associated only with alexithymia (TAS-20 total score) and insulin therapy. CONCLUSIONS Alexithymia more than depression influences glycaemic control. When evaluating a diabetic patient, a rapid screening for psychopathological alterations would guarantee a more accurate management. The treatment of any associated psychiatric disorders would improve the patients' quality of life.
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Affiliation(s)
- A Luca
- Department "GF Ingrassia", Section of Neuroscience, University Hospital "Policlinico-Vittorio Emanuele" of Catania (Sicily), Via S. Sofia 78, 95100, Catania, Italy
| | - M Luca
- Department of Medical and Surgery Specialties, Psychiatry Unit of the University Hospital "Policlinico-Vittorio Emanuele" of Catania (Sicily), Via S. Sofia 78, 95100, Catania, Italy
| | - M Di Mauro
- Department of Clinical and Molecular Biomedicine, Andrology and Endocrinology Unit, University Hospital "Policlinico-Vittorio Emanuele" of Catania (Sicily), Via S. Sofia 78, 95100, Catania, Italy
| | - F Palermo
- Department of Clinical and Molecular Biomedicine, Infectious Diseases Unit, University of Catania, ARNAS Garibaldi Nesima, Catania (Sicily), Via Palermo 636, 95122, Catania, Italy
| | - F Rampulla
- Department of Medical and Surgery Specialties, Psychiatry Unit of the University Hospital "Policlinico-Vittorio Emanuele" of Catania (Sicily), Via S. Sofia 78, 95100, Catania, Italy
| | - C Calandra
- Department of Medical and Surgery Specialties, Psychiatry Unit of the University Hospital "Policlinico-Vittorio Emanuele" of Catania (Sicily), Via S. Sofia 78, 95100, Catania, Italy.
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Maniaci G, Picone F, Dimarco T, Lipari A, Brancato A, Cannizzaro C. Psychodiagnostic Assessment of Pathological Gamblers: A Focus on Personality Disorders, Clinical Syndromes and Alexithymia. Int J Ment Health Addict 2015. [DOI: 10.1007/s11469-015-9550-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Hua J, Le Scanff C, Larue J, José F, Martin JC, Devillers L, Filaire E. Global stress response during a social stress test: impact of alexithymia and its subfactors. Psychoneuroendocrinology 2014; 50:53-61. [PMID: 25179321 DOI: 10.1016/j.psyneuen.2014.08.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 08/04/2014] [Accepted: 08/04/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Alexithymia is a personality trait characterized by difficulties in identifying, describing and communicating one's own emotions. Recent studies have associated specific effects of this trait and its subfactors with hypothalamo-pituitary-adrenal (HPA) axis markers during stress. The aim of this study was to analyze the association between alexithymia and its subfactors with HPA and sympatho-adrenal medullar (SAM) activity. Stress was induced experimentally using a public-speaking paradigm. Salivary cortisol, alpha-amylase (AA), chromogranin A (CgA) and heart rate (HR) were collected during the defined periods of baseline, stress, and recovery in 19 males and 24 female healthy university students. RESULTS Subjects reacted to the stressor with a significant cortisol and SAM response. Subjects scoring high on alexithymia reacted significantly more intensely than low scorers in basal anticipatory as well as peak cortisol and area under the curve. Regression analyses revealed that the increased HPA activity was related to only one alexithymia subfactor, the difficulty in differentiating feelings and distinguishing them from bodily sensations and emotion arousal. CONCLUSION Alexithymia and its subfactors were specifically related to cortisol responses. This research should be replicated with more subjects and should take into account more parameters reflecting sympathetic and/or parasympathetic activation, as well as HPA axis. Factors such as coping strategies and the perception of the situation as a challenge have also to be explored.
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Affiliation(s)
- Jiewen Hua
- Laboratory CIAMS, EA4532, UFR STAPS, University Paris-Sud, 91405 Orsay, France
| | - Christine Le Scanff
- Laboratory CIAMS, EA4532, UFR STAPS, University Paris-Sud, 91405 Orsay, France
| | - Jacques Larue
- Laboratory CIAMS, EA4532, UFR STAPS, University Paris-Sud, University Orléans, 45067 Orléans, France
| | - Ferreira José
- Research Center for Sport and Physical Activity, Faculty of Sport Sciences and Physical Education, University of Coimbra, Portugal
| | | | - Laurence Devillers
- LIMSI-CNRS, UPR 3251, University Paris-Sud, University Paris Sorbonne, 91405 Orsay, France
| | - Edith Filaire
- Laboratory CIAMS, EA4532, UFR STAPS, University Paris-Sud, University Orléans, 45067 Orléans, France.
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Abstract
Earlier studies demonstrated that adult emotional competences (EC) can be improved through relatively brief training. This increase has been investigated, thus far, using self-reported questionnaires and behavioral data. The aim of the present study was to evaluate the cerebral correlates underlying improvement in EC. An experimental group received an EC training and a control group received brief sessions of drama improvisation. Participants viewed negative, positive, and neutral pictures while attempting to decrease, increase, or not modulate their emotional reactions. Subjective reactions were assessed via on-line ratings. After the intervention, the training group showed less cerebral activity as compared to the control group within different regions related to emotional regulation and attention including prefrontal regions and the bilateral inferior parietal lobule, the right precentral gyrus and the intraparietal sulcus. These results suggest increased neural efficiency in the training group as a result of emotional competencies training.
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Affiliation(s)
| | | | | | - Eric Salmon
- Cyclotron Research Centre, University of Liège, Belgium
| | - Steve Majerus
- Department of Psychology, University of Liège, Belgium
- Belgian National Fund for Scientific Research (FNRS), Belgium
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Lemche AV, Chaban OS, Lemche E. Alexithymia as a risk factor for type 2 diabetes mellitus in the metabolic syndrome: a cross-sectional study. Psychiatry Res 2014; 215:438-43. [PMID: 24388726 DOI: 10.1016/j.psychres.2013.12.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2012] [Revised: 08/13/2013] [Accepted: 12/04/2013] [Indexed: 01/01/2023]
Abstract
Alexithymia is a clinical trait consisting of diminished introspective and interoceptive capacities that has been shown to implicate elevated autonomic outflow and to bias for hypertension. To estimate relative risk associated with alexithymia in the metabolic syndrome (MetS), we conducted a cross-sectional analysis of patients with manifest type 2 diabetes mellitus (T2DM) or familial diabetes risk (N=101; 67 females; age 45.6±13.96) in a nationwide sampled treatment cohort for MetS in the Ukrainian governmental health care system. Laboratory data of single components of the MetS according to International Diabetes Federation Consensus were dependent measures in multivariable regression models with self-reported alexithymia severity (TAS-20) and socio-demographic data. TAS-20 as the sole surviving psychometric predictor for T2DM in the simplest regression equation provided the best model fit: OR 1.073, Z=19.04, (95%CIs 1.065-1.081). For microalbuminuria, the best fitting model was OR 1.030, Z=3.49 (95%CIs 1.013-1.048). TAS-20 predicted also triglyceride level at Wald-χ(2)=1299.27, Z=36.05 (95%CIs 0.052-0.058) and blood pressure maximum at Wald-χ(2)=2309.05, Z=48.05 (95%CIs 2.402-2.606). Our results show that alexithymia severity contributes to MetS by covarying with several of its single components, and that it may be a substantial concurrent indicator of T2DM and cardiovascular risks in MetS.
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Affiliation(s)
- Alexandra V Lemche
- Department of Psychosomatic Medicine, Charité University Medicine Berlin, Germany
| | - Oleg S Chaban
- Section of Neuroses and Somatoform Disorders, Bogolomets National Medical University, Kiev, Ukraine
| | - Erwin Lemche
- Section of Cognitive Neuropsychiatry, Institute of Psychiatry, King's College London, UK.
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Vieira RVDA, Vieira DC, Gomes WB, Gauer G. Alexithymia and its impact on quality of life in a group of Brazilian women with migraine without aura. J Headache Pain 2013; 14:18. [PMID: 23565860 PMCID: PMC3620425 DOI: 10.1186/1129-2377-14-18] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Accepted: 02/06/2013] [Indexed: 11/13/2022] Open
Abstract
Background Migraine is a type of primary headache widely known for its impact on quality of life of patients. Although the psychological aspects of the disease are receiving increasing attention in current research, some of them, as alexithymia, are still seldom explored. This study aimed to provide evidence on the relationships between markers of depression, anxiety, alexithymia, self-reflection, insight and quality of life in migraine. Methods Forty female outpatients from a Brazilian specialized headache hospital service and a paired control group were compared. Results The results revealed that women with migraine had higher levels of depression, anxiety and alexithymia, and lower levels of quality of life, self-reflection and insight, compared to controls. Quality of life in women with migraine was predicted by levels of depression and one alexithymia factor (ability to express emotions and fantasies). A binary regression analysis between clinical and control groups revealed the migraine group to comprise individuals with high anxiety, low quality of life in the physical domain and the presence of a concrete thinking style. Conclusions The results highlight the relevance of considering psychological variables in the routine healthcare practices for migraine patients in general, while keeping steady attention to individual case features.
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Kojima M. Alexithymia as a prognostic risk factor for health problems: a brief review of epidemiological studies. Biopsychosoc Med 2012; 6:21. [PMID: 23244192 PMCID: PMC3546882 DOI: 10.1186/1751-0759-6-21] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Accepted: 12/13/2012] [Indexed: 11/30/2022] Open
Abstract
The number of articles on alexithymia has been steadily increasing since the word “alexithymia” was coined in the 1970s to denote a common characteristic that is observed among classic psychosomatic patients in whom therapy was unsuccessful. Alexithymia, a disorder of affect regulation, has been suggested to be broadly associated with various mental and physical health problems. However, most available evidence is based on anecdotal reports or cross-sectional observations. To clarify the predictive value of alexithymia for health problems, a systematic review of prospective studies was conducted. A search of the PubMed database identified 1,507 articles on “alexithymia” that were published by July 31, 2011. Among them, only 7 studies examined the developmental risks of alexithymia for health problems among nonclinical populations and 38 studies examined the prognostic value of alexithymia among clinical populations. Approximately half of the studies reported statistically significant adverse effects, while 5 studies demonstrated favorable effects of alexithymia on health outcomes; four of them were associated with surgical interventions and two involved cancer patients. The studies that showed insignificant results tended to have a small sample size. In conclusion, epidemiological evidence regarding alexithymia as a prognostic risk factor for health problems remains un-established. Even though alexithymia is considered to be an unfavorable characteristic for disease control and health promotion overall, some beneficial aspects are suggested. More prospective studies with sufficient sample sizes and follow-up period, especially those involving life course analyses, are needed to confirm the contribution of alexithymia to health problems.
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Affiliation(s)
- Masayo Kojima
- Department of Public Health, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan.
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Cantisano N, Rimé B, Muñoz-Sastre MT. The social sharing of emotions in HIV/AIDS: A comparative study of HIV/AIDS, diabetic and cancer patients. J Health Psychol 2012; 18:1255-67. [DOI: 10.1177/1359105312462436] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Studies have shown that chronic illness patients encounter difficulties in the social sharing of emotions. Do HIV/AIDS patients present distinguishing traits in the inhibition of illness and non-illness-related emotions? The differences in the social sharing of emotion between 35 HIV/AIDS, 35 diabetic and 34 cancer outpatients were studied. A questionnaire assessed illness-related emotions, social sharing of emotion and emotional inhibition. The HIV/AIDS group significantly presented superior scoring in shame, guilt and non-sharing of illness-related emotions, lower frequencies of social sharing of emotion and less sharing partners. These findings could lead to future research examining the emotional expression of guilt and shame in HIV/AIDS.
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Barbosa F, Mota C, Patrício P, Alcântara C, Ferreira C, Barbosa A. The relationship between alexithymia and psychological factors in systemic lupus erythematosus. Compr Psychiatry 2011; 52:754-62. [PMID: 21193176 DOI: 10.1016/j.comppsych.2010.11.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2010] [Revised: 11/04/2010] [Accepted: 11/14/2010] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Alexithymia has been described as an important dimension in several medical diseases. Systemic lupus erythematosus (SLE) is a chronic condition characterized by unpredictable clinical manifestations. Our aim is to reveal which factors (psychological factors and quality of life dimensions) are associated with alexithymia in SLE patients. METHODS Fifty-three sequential SLE patients (ACR criteria) and 41 asthma patients were studied by means of validated scales for alexithymia (Toronto Alexithymia Scale), psychopathology (Brief Symptom Inventory, Hospital Anxiety and Depression Scale), personality dimensions (NEO-FFI), and quality of life (Short Form-36 Health Survey). Systemic lupus erythematosus patient's clinical and laboratorial evaluation was performed by indicators of activity (Systemic Lupus Erythematosus Disease Activity Index) of accumulated damage (Systemic Lupus International Collaborating Clinics/ACR Damage Index), length of disease, and therapy. RESULTS An association between alexithymia and psychopathological symptoms, and personality and quality of life dimensions was found. By means of multiple regression analysis, openness and depression were the 2 predictors for alexithymia in SLE patients. We found a high prevalence rate of alexithymia in SLE patients; however, when controlling for depression symptoms (Hospital Anxiety and Depression Scale-Depression, <7), we found a lower percentage of alexithymic traits than that of the total sample of SLE. CONCLUSION Alexithymia was associated with psychological distress and with quality of life impairment. Understanding the role of psychological factors in SLE patients may contribute to a more comprehensive perspective of the disease, its impact on patient's daily routine, and how patients adapt emotionally to a chronic disease.
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Lahaye M, Fantini-Hauwel C, Van Broeck N, Bodart E, Luminet O. Emotional competence and quality of life of children with asthma: The mediating effect of coping strategies. Psychol Health 2011; 26:1678-95. [PMID: 21678192 DOI: 10.1080/08870446.2011.562606] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study explored the mediating effect of coping strategies on the relationship between emotional competence (EC) and quality of life (QOL) among children with asthma. Participants were 87 children (M age = 11.72, SD = 2.58) with controlled and partially controlled asthma, undergoing everyday treatment. They filled in questionnaires assessing EC, coping strategies and QOL. Results showed that the association between some ECs and the QOL of children with asthma was fully mediated by two maladaptive cognitive coping strategies. Among children with asthma, a greater ability to differentiate their emotions, a reduced attention to bodily signals of emotions and a reduced analysis of their current emotional state were related to decreased engagement in two coping strategies ('Ignoring Asthma' and 'Worrying about Asthma'), which in turn increased their QOL. These findings show that EC has an indirect effect on QOL through very specific coping strategies. They also emphasise the importance of screening EC in children with asthma and the importance of developing and using multidisciplinary interventions for them.
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Affiliation(s)
- Magali Lahaye
- Psychological Sciences Research Institute, Université catholique de Louvain, Louvain-la-Neuve, Belgium.
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Housiaux M, Luminet O, Van Broeck N, Dorchy H. Alexithymia is associated with glycaemic control of children with type 1 diabetes. Diabetes Metab 2010; 36:455-62. [PMID: 20863735 DOI: 10.1016/j.diabet.2010.06.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2009] [Revised: 06/03/2010] [Accepted: 06/09/2010] [Indexed: 12/15/2022]
Abstract
AIM This study examined the respective contributions of the demographics, medical variables and alexithymia characteristics of young diabetics to their glycaemic control. The goal was to replicate the role of the 'difficulty describing feelings' factor of alexithymia in the prediction of poor glycaemic control as has been found in adult diabetic populations. METHOD The study included 45 type 1 diabetic children, aged 8-12 years (24 girls and 21 boys). Participants completed a sociodemographic questionnaire and provided medical information on their diabetes. HbA(1c) values (glycated haemoglobin), and the number of severe hypoglycaemic episodes and hospitalizations for hyperglycaemia, were collected for the previous 12 months (3 months for severe hypoglycaemias). Alexithymia characteristics were measured by means of the Alexithymia Questionnaire for children. RESULTS Hierarchical regression analyses confirmed that both demographic (marital status and parental education; P<0.05) and medical (duration of diabetes and daily self-monitoring of blood glucose frequency; P<0.01) variables are associated with HbA(1c) levels. More important, one alexithymia factor (difficulty describing feelings) was found to be an additional predictor over and above the other variables (P<0.01), explaining an additional 12% of the total variance in HbA(1c) levels. CONCLUSION Confirming results already observed in diabetic adults, the present findings show, for the first time, that children who have difficulties in expressing their feelings to others are more at risk of poor glycaemic control. In future, it will be useful to identify the diabetic young people who have such difficulties and to consider interventions designed specifically for them.
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Affiliation(s)
- M Housiaux
- Department of Psychology, université catholique de Louvain (UCL), Research institute for Psychological Sciences, 10 place Cardinal-Mercier, Louvain-la-Neuve, Belgium
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Chatzi L, Bitsios P, Solidaki E, Christou I, Kyrlaki E, Sfakianaki M, Kogevinas M, Kefalogiannis N, Pappas A. Type 1 diabetes is associated with alexithymia in nondepressed, non-mentally ill diabetic patients: a case-control study. J Psychosom Res 2009; 67:307-13. [PMID: 19773023 DOI: 10.1016/j.jpsychores.2009.04.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2008] [Revised: 04/27/2009] [Accepted: 04/28/2009] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Alexithymia refers to difficulty in identifying and expressing emotions, and it is a characteristic common to several psychiatric and medical conditions, including autoimmune disorders. Type 1 diabetes (T1D) is an autoimmune disorder with increased psychiatric comorbidity. Previously reported associations between alexithymia and T1D may have been confounded by the presence of depression. The central aim of this study was to examine alexithymia levels in psychiatrically uncomplicated T1D outpatients with that of nondiabetic controls. METHODS Ninety-six T1D patients without any DSM-IV Axis I diagnoses and 105 age- and sex-matched healthy controls entered the study. Alexithymia and depressive symptoms were assessed with the Toronto Alexithymia Scale (TAS-20) and the Beck Depression Inventory (BDI-21), respectively. Multivariate regression models were used to evaluate the association of alexithymia with the presence of diabetes, duration of diabetes, diabetes control, parameters of treatment intensification, and diabetic complications. RESULTS T1D was positively associated with the TAS-20 "identifying feelings" (beta coefficient=2.64, P=.003) and "externally oriented thinking" (beta coefficient=1.73, P=.011) subscales. The prevalence of overall alexithymia (TAS-20 total score, > or =60) was 22.2% in T1D patients and 7.6% in the controls (OR, 4.6; 95% CI, 1.7-12.8). TAS-20 scores were positively associated with diabetes duration and negatively with treatment intensification parameters. CONCLUSIONS Alexithymia is higher in psychiatrically uncomplicated T1D patients than in healthy controls even after adjustment for confounding depressive symptoms; it is greater with longer diabetes duration and is associated with some reduced parameters of treatment intensification but not with worse outcome in terms of glycemic control or somatic complications.
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Affiliation(s)
- Leda Chatzi
- Faculty of Medicine, Department of Social Medicine, University of Crete, Crete, Greece.
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Barbosa F, Mota C, Alves M, Alcântara C, Rossiñol B, Patrício P, Barbosa A, Ferreira C. Alexithymia in Systemic Lupus Erythematosus Patients. Ann N Y Acad Sci 2009; 1173:227-34. [DOI: 10.1111/j.1749-6632.2009.04640.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Meunier J, Dorchy H, Luminet O. Does family cohesiveness and parental alexithymia predict glycaemic control in children and adolescents with diabetes? Diabetes Metab. 2008;34:473-481. [PMID: 18783976 DOI: 10.1016/j.diabet.2008.03.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2007] [Revised: 03/05/2008] [Accepted: 03/10/2008] [Indexed: 12/16/2022]
Abstract
AIM Several studies indicate that family functioning and parental expressiveness can influence children's glycaemic control. However, previous studies have had contradictory findings. Furthermore, no previous work has simultaneously explored the mother's and father's perception of family cohesiveness together with maternal and paternal alexithymia in relation to a child's diabetic control. In this study, we examined whether the parental perception of family cohesion and the parents' degree of alexithymia could predict their child's or adolescent's glycaemic control (severe hypoglycaemia, hospitalizations for hyperglycaemia and HbA(1c)) after adjusting for demographic variables. METHODS The study included 45 Belgian families with at least one type 1 diabetic child aged six to 18 years (25 girls and 20 boys). Parents completed demographic questionnaires about themselves and their children. Information on type 1 diabetes in their child and the family-medical history were also collected. The number of severe-hypoglycaemic events and hospitalizations for hyperglycaemia were documented for the last 12 months, as were HbA(1c) levels over the last 16 months. Finally, family cohesiveness (FACES-III) and parental alexithymia (TAS-20) were assessed. RESULTS Hierarchical regression analyses showed that the perception of family cohesion by mothers (P<0.05) was a predictor of the number of severe hypoglycaemic events in the last 12 months. Parents' demographic variables (marital and professional status, P<0.001) and maternal alexithymia (P<0.05) were found to be predictors of the number of hospitalizations for hyperglycaemia in the last 12 months. As for HbA(1c), only two parental demographic variables were significant predictors (marital and professional status, P<0.01 and P<0.05, respectively). CONCLUSION The maternal perception of family cohesiveness and maternal alexithymia predict on glycaemic control in children and adolescents with diabetes.
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de Timary P, Roy E, Luminet O, Fillée C, Mikolajczak M. Relationship between alexithymia, alexithymia factors and salivary cortisol in men exposed to a social stress test. Psychoneuroendocrinology 2008; 33:1160-4. [PMID: 18674866 DOI: 10.1016/j.psyneuen.2008.06.005] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2007] [Revised: 05/31/2008] [Accepted: 06/02/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND The fact that alexithymia is associated with several medical and psychiatric disorders suggests that it may be a vulnerability factor for various diseases, possibly by enhancing stress responses. To test this "alexithymia-stress hypothesis", we measured the influence of alexithymia and alexithymia subfactors on the cortisol response to an acute stressor. METHODS Twenty-eight male students were exposed to the Trier Social Stress Test (TSST), during which saliva samples for cortisol determination were collected. RESULTS Subjects reacted to the stressor with a significant cortisol response. Subjects scoring high on alexithymia evidenced an increased basal anticipatory cortisol level but their peak cortisol and area under the curve were similar to that of low scorers. Multiple regression analyses revealed that the increased cortisol in high scorers was due to only one subfactor of alexithymia, "the difficulty in describing feelings" factor (DDF). DDF high scorers reacted with a large increase in cortisol during anticipation but not during exposure to the stress test. CONCLUSION The observation that alexithymia scores were associated with differences in cortisol levels before social stress exposure raises the possibility that alexithymia modulates cortisol levels, possibly by affecting the anticipatory cognitive appraisal of situations. This may be essentially attributed to the DDF factor. This observation sheds new light on the "alexithymia-stress hypothesis", which may be of importance to better understand the relationship between alexithymia and diseases. Further studies to address this issue should focus on the factorial structure of the construct and on the importance of anticipation.
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Affiliation(s)
- Philippe de Timary
- Université Catholique de Louvain, Cliniques Universitaires Saint Luc, Avenue Hippocrate 10, B-1200 Brussels, Belgium.
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Bibliography. Current world literature. Diabetes and the endocrine pancreas II. Curr Opin Endocrinol Diabetes Obes 2007; 14:329-57. [PMID: 17940461 DOI: 10.1097/MED.0b013e3282c3a898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Luminet O, Rokbani L, Ogez D, Jadoulle V. An evaluation of the absolute and relative stability of alexithymia in women with breast cancer. J Psychosom Res 2007; 62:641-8. [PMID: 17540221 DOI: 10.1016/j.jpsychores.2007.01.003] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2006] [Revised: 01/02/2007] [Accepted: 01/04/2007] [Indexed: 01/12/2023]
Abstract
OBJECTIVES In the controversy for alexithymia as a state or a trait dimension, recent studies showed that, whereas absolute changes (i.e., extent of alexithymia scores change over time) were observed, alexithymia was relatively stable (i.e., extent to which relative differences among individuals remain the same over time). The present study extended this question by investigating a disease with highly threatening outcomes (breast cancer), by looking at changes in depression and anxiety, and by examining stability for total and factor alexithymia scores. METHODS One hundred twenty-two women in treatment for a first instance of breast cancer were assessed for alexithymia (TAS-20), depression, and anxiety (HADS) the day before surgery (T1) and six months later (T2). RESULTS Alexithymia scores changed from baseline to follow-up (lack of absolute stability). Strong evidence of relative stability was also demonstrated, as alexithymia scores at baseline correlated significantly with alexithymia scores at follow-up and were also a significant predictor of follow-up alexithymia scores, after partialling the effects of depression and anxiety severity. Changes in alexithymia were explained only to a small extent by changes in depression and anxiety from T1 to T2. Results at the factor level revealed that "difficulty identifying feelings" follow-up and change score accounted for the highest variations in depression and anxiety, and "externally oriented thinking" for the lowest ones. CONCLUSIONS The finding of relative stability of alexithymia supports the view that this construct is a stable personality trait rather than a state-dependent phenomenon, even in a context of high threat for physical and psychological integrity.
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Affiliation(s)
- Olivier Luminet
- Department of Psychology, Université catholique de Louvain, Louvain-la-Neuve, Belgium.
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